Podcast
Questions and Answers
What is the required change in FEV1 to indicate a significant between-visit variability?
What is the required change in FEV1 to indicate a significant between-visit variability?
Which of the following statements is true regarding diurnal PEFR variability in adults?
Which of the following statements is true regarding diurnal PEFR variability in adults?
Which of the following challenges requires a fall in FEV1 of more than 20% to be considered positive?
Which of the following challenges requires a fall in FEV1 of more than 20% to be considered positive?
How are PD20 and PC20 values compared in terms of device performance?
How are PD20 and PC20 values compared in terms of device performance?
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What indicates borderline asthma severity according to PD20 levels?
What indicates borderline asthma severity according to PD20 levels?
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What does the term ‘asthma’ originate from in Greek?
What does the term ‘asthma’ originate from in Greek?
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Which of the following best describes the nature of asthma?
Which of the following best describes the nature of asthma?
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Which type of immune response is primarily seen in eosinophilic asthma?
Which type of immune response is primarily seen in eosinophilic asthma?
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What aspect does 'endotyping' in asthma refer to?
What aspect does 'endotyping' in asthma refer to?
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Which factor is NOT typically considered a risk factor for asthma?
Which factor is NOT typically considered a risk factor for asthma?
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What is a characteristic feature of airway hyperresponsiveness in asthma?
What is a characteristic feature of airway hyperresponsiveness in asthma?
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What type of asthma is poorly steroid responsive?
What type of asthma is poorly steroid responsive?
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Which of the following is NOT a component of asthma pathophysiology?
Which of the following is NOT a component of asthma pathophysiology?
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What is the prevalence of GERD in asthmatics according to esophageal pH-monitoring studies?
What is the prevalence of GERD in asthmatics according to esophageal pH-monitoring studies?
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Which symptom is NOT commonly associated with GERD in asthma patients?
Which symptom is NOT commonly associated with GERD in asthma patients?
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What is the primary characteristic of Chronic Rhino-Sinusitis (CRS)?
What is the primary characteristic of Chronic Rhino-Sinusitis (CRS)?
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How prevalent is Chronic Rhino-Sinusitis in individuals with severe asthma?
How prevalent is Chronic Rhino-Sinusitis in individuals with severe asthma?
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What describes the relationship between asthma and Chronic Rhino-Sinusitis?
What describes the relationship between asthma and Chronic Rhino-Sinusitis?
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What is the definition of severe asthma according to the guidelines?
What is the definition of severe asthma according to the guidelines?
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What treatment outcome is associated with sino-nasal disease in asthma patients?
What treatment outcome is associated with sino-nasal disease in asthma patients?
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What is the inconsistency regarding the treatment of GERD in asthma patients?
What is the inconsistency regarding the treatment of GERD in asthma patients?
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What percentage of asthma patients are reported to have obstructive sleep apnea (OSA)?
What percentage of asthma patients are reported to have obstructive sleep apnea (OSA)?
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Which comorbidity is associated with the highest prevalence among asthma patients?
Which comorbidity is associated with the highest prevalence among asthma patients?
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Which of the following best describes asthma management according to the GINA report?
Which of the following best describes asthma management according to the GINA report?
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The treatment outcome for which coexisting condition in asthma is noted to be inconsistent?
The treatment outcome for which coexisting condition in asthma is noted to be inconsistent?
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Which GINA step indicates the need for the highest level of asthma treatment?
Which GINA step indicates the need for the highest level of asthma treatment?
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What role does IL-5 play in eosinophilic inflammation?
What role does IL-5 play in eosinophilic inflammation?
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Which cytokines are classified as epithelial alarmins in type 2 asthma?
Which cytokines are classified as epithelial alarmins in type 2 asthma?
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What is the primary treatment method for Exercise Induced Bronchoconstriction (EIB)?
What is the primary treatment method for Exercise Induced Bronchoconstriction (EIB)?
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What mechanism contributes to asthma in smokers?
What mechanism contributes to asthma in smokers?
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Which cytokine primarily facilitates IgE production by B-cells?
Which cytokine primarily facilitates IgE production by B-cells?
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What diagnostic test is commonly used for Exercise-Induced Asthma?
What diagnostic test is commonly used for Exercise-Induced Asthma?
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What characterizes asthma-COPD overlap (ACO) conditions?
What characterizes asthma-COPD overlap (ACO) conditions?
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Which of the following cytokines is NOT produced by helper T cells, basophils, mast cells, or eosinophils?
Which of the following cytokines is NOT produced by helper T cells, basophils, mast cells, or eosinophils?
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Which symptom is commonly associated with Exercise Induced Bronchoconstriction during exercise?
Which symptom is commonly associated with Exercise Induced Bronchoconstriction during exercise?
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What effect does smoking have on the risk of developing asthma?
What effect does smoking have on the risk of developing asthma?
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What is a significant effect of obesity on asthma management?
What is a significant effect of obesity on asthma management?
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Which dietary pattern is most strongly associated with better asthma management?
Which dietary pattern is most strongly associated with better asthma management?
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What characterizes occupational asthma?
What characterizes occupational asthma?
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What is a poor consequence of obesity on respiratory function?
What is a poor consequence of obesity on respiratory function?
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Which of the following comorbidities is NOT associated with obesity?
Which of the following comorbidities is NOT associated with obesity?
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What type of exercise is supported in recent studies for improving asthma in obese patients?
What type of exercise is supported in recent studies for improving asthma in obese patients?
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What is the role of adipose tissue in obesity-related asthma?
What is the role of adipose tissue in obesity-related asthma?
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Which statement about immunological occupational asthma is false?
Which statement about immunological occupational asthma is false?
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Study Notes
Bronchial Asthma
- Asthma originates from the Greek word "aazein," meaning "short-drawn breath" or "panting."
- Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation.
- Symptoms vary in intensity and over time, with variable expiratory airflow limitation.
Gene/Environment Interactions
- Asthma development is influenced by both genetic and environmental factors.
- Maternal exposure to toxins and smoking have a role in prenatal development.
- Viral infections during infancy can affect immune development and contribute to asthma onset.
- Environmental factors, such as allergens and pollutants, play a role in childhood and adult lung development.
- Over time, airway hyperresponsiveness, tissue remodeling, and exacerbation/progression can contribute to the disease.
- Epigenetic modifications can also impact the development and progression of the disease.
Objectives
- Understanding asthma definition, epidemiology, and risk factors.
- Detailed look at immunology and pathophysiology.
- Analyzing endotyping and phenotyping concepts.
- Precise and accurate evaluation of asthma.
- Clinical guidelines for stepped treatment in mild, moderate, and severe cases.
- Assessment of occupational asthma.
Asthma Pathophysiology
- Airway hyperresponsiveness is a key feature.
- Airway remodeling is part of continued inflammation.
- Mucus hypersecretion is another important feature.
- Smooth muscle hypertrophy is also prominent.
T2 High vs T2 Low
- T2 high asthma usually has a rapid onset (early onset) and is associated with allergies, eosinophils, and response to steroids.
- T2 low asthma typically has a late onset and may be associated with poor steroid response.
- These distinctions are used for diagnosis and treatment approach
Type-2 Immune Responses in Asthma
- Allergens and other triggers (pollutants, microbes) activate type-2 immune responses resulting in inflammatory symptoms.
- Goblet cells, airway epithelium, and immune cells (Th2 cells, mast cells, eosinophils, basophils, ILC2s) play crucial roles in this process.
- Cytokines (IL-4, IL-5, IL-13, IL-25, TSLP) are key mediators in type-2 inflammation driving symptoms in asthma.
Asthma Control and Severity
- A minimum level of treatment is crucial for control.
- Asthma control is indicated by the degree to which treatment minimizes symptoms and risk.
- Asthma severity is evaluated through symptoms and prediction of future risk.
- Various factors like daytime/nighttime symptoms, rescue medication use, activity limitations, and frequency of exacerbations are used for assessment.
- Different treatment approaches are employed based on specific classifications (mild, moderate, severe).
Classifying Asthma Severity (NAEPP EPR3 2007)
- Evaluates symptoms over time, including nighttime awakenings and rescue medication use.
- Checks for interference with daily activities and measures lung function (FEV1).
- Assesses exacerbation frequency and identifies levels of risk.
- Uses classifications like intermittent, mild, moderate, and severe to guide treatment.
Asthma Management
- Assessment, adjustment, and review are all important for asthma management.
- Diagnosis confirmation is necessary.
- Symptom control and modifiable risk factors should be addressed.
- Patients need to be educated on treatment, including medication use, technique, and adherence plans.
- Treatment of comorbidities and education.
Inhaler Abbreviations
- SABA: Short-Acting Beta Agonist (e.g., Albuterol)
- SAMA: Short-Acting Muscarinic Antagonist (e.g., Ipratropium)
- LABA: Long-Acting Beta Agonist (e.g., Salmeterol)
- LAMA: Long-Acting Muscarinic Antagonist (e.g., Tiotropium)
- ICS: Inhaled Corticosteroids
Severe Asthma Definition
- Severe asthma requires high-dose/systemic corticosteroids (ICS) to prevent uncontrolled symptoms for prolonged periods.
- Asthma that doesn't improve despite treatment can be categorized as severe.
- Controlled asthma worsening on reducing high-dose ICS/systemic CS may also be classified as severe.
Comorbidities in Difficult Asthma
- Common comorbidities in difficult-to-treat asthma include sinonasal diseases (allergic rhinitis, CRSwNP), gastroesophageal reflux disease (GERD), obstructive sleep apnea (OSA), and vocal cord dysfunction.
- Treatment may not always improve issues associated with comorbid conditions.
GERD & Asthma
- GERD is often associated with asthma symptoms and there is evidence of a bi-directional relationship.
- The prevalence of GERD in asthmatic patients suggests it either triggers or worsens asthma in some cases.
- Evaluation for GERD is crucial for asthmatic patients as treatment can improve associated symptoms.
CRS & Asthma
- Inflammation of the paranasal sinuses and nasal cavity (CRS) has a link with asthma.
- The unified airway model proposes a shared systemic inflammatory pathway between upper and lower airways.
- CRS is common in asthma patients, especially severe asthma cases.
- Diagnosis and control can result in lower lung function but may also impact quality of life.
Obesity & Asthma
- Obesity is often associated with worse asthma control, increased health care utilization, and reduced response to standard controller therapy.
- Weight loss via dietary changes, exercise, or surgically, may show positive results in improving asthma.
- Diet (quality, high protein/low glycemic index, and plant based/Mediterranean) is linked to asthma symptoms and may improve outcomes.
Occupational Asthma (OA)
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Occupational asthma (OA) is caused by exposure to workplace environmental factors that may not be encountered outside the work environment.
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OA is categorized as either immunological (sensitizing) or non-immunological.
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Distinguishing OA from workplace-exacerbated asthma is crucial for appropriate diagnosis and treatment.
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Suspecting OA involves monitoring and evaluating symptoms related to workplace environment.
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Symptoms potentially improve over weekends or holidays but increase during work hours, are crucial indicators.
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This is common and workplace-related triggers need to be identified and controlled for diagnosis.
- Common triggers include high-molecular-weight agents (e.g., flour, animal proteins, latex) and low-molecular-weight agents (e.g., diisocyanates, metals).
Methacholine Challenge Test
- Methacholine testing helps determine airway responsiveness in patients suspected to have asthma.
- PD20 and PC20 (dose of methacholine needed to induce a 20% fall in FEV1) are used to classify severity, which provides valuable information for tailored treatment plans.
Acute Asthma Exacerbation Management
- Initial assessment includes airway, breathing, and circulation evaluation of patients.
- Appropriate triage of patients is needed to determine the severity & potential treatment required.
- Mild or moderate: short-acting bronchodilators (SABA), ipratropium bromide, and oral/IV corticosteroids are used.
- Severe exacerbation requires treatment and management similar to moderate asthma but with higher dosages of medications.
- Continuous monitoring and adjustment of treatment are crucial.
Levels of Acute Asthma Severity
- Levels of severity are determined based on characteristics like increasing symptoms, reduced peak expiratory flow rate (PEFR), respiratory rate, and heart rate.
- Severe asthma can lead to life-threatening complications.
- Levels are assessed as indicators to guide medical interventions and determine prognosis.
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Description
Test your knowledge on asthma pathophysiology, variability in lung function indices, and related immune responses. This quiz covers essential concepts including FEV1 changes, diurnal variability, and the nature of asthma. Perfect for students and professionals in respiratory health.
